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Updated: Oct 26, 2025
An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Pressure Injury Development, Mitigation, and Outcomes of Patients Proned for Acute Respiratory Distress Syndrome
Virginia Capasso1, Colleen Snydeman, Karen Miguel
1At Massachusetts General Hospital in Boston, Virginia Capasso, PhD, CNP, ACNS-BC, CWS, FACCWS, is Nurse Scientist, Yvonne L. Munn Center for Nursing Research; Colleen Snydeman, PhD, RN, is Executive Director; Karen Miguel, MM-H, RN, is Staff Specialist; Xianghong Wang, MS, is Senior Analyst; Michelle Crocker, BSN, RN, is Staff Nurse, Cardiac ICU; Zachary Chornoby, BSN, RN, CCRN, is Staff Nurse, Cardiac ICU; Mark Vangel, PhD, is Statistician, Marino Center for Radiology; Mary Ann Walsh, BSN, RN, is Nurse Clinician; John Murphy, DNP, RN, is Staff Specialist, Center for Quality & Safety; and Stephanie Qualls, MSN, RN, is Clinical Nurse Specialist, Neuroscience ICU.
Objective:
To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs.
Methods:
The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics. Differences between groups with and without PIs were analyzed.
Results:
Among 147 patients, significant PI risk factors included male sex (P = .019), high body mass index (>40 kg/m2; P = .020), low Braden Scale score (<12; P = .018), and low-dose vasopressor therapy (P = .020). Taping endotracheal tubes (ETTs) caused significantly fewer facial PIs than commercial ETT holders (P < .0001). Maximum prone duration/session was a significant risk factor for anterior PIs (P = .016), which dropped 71% with newer pressure redistribution products. d-Dimer greater than 3,200 μg/mL (P = .042) was a significant risk factor for sacrococcygeal PIs while supine. Mortality was 30%; significant risk factors included age older than 60 years (P = .005), Sequential Organ Failure Assessment score greater than 11 (P = .003), and comorbid congestive heart failure (P = .016).
Conclusions:
Taping the ETT, limiting the maximum duration of prone positioning to less than 32 hours, and frequent repositioning while supine may reduce the number of modifiable risk factors for PIs. Standardized methods for testing products for PI prevention will inform individualized patient care.
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